Beyond C-7 and death on demand -- competent choice is the new frontier, or death with no demand

Gordon Friesen

By Gordon Friesen, EPC board member
http://www.euthanasiediscussion.net/

Euthanasia has two faces in Canada. The first is Voluntary Euthanasia, which is a practice based upon the assumed right of an individual to control his, or her, own destiny. Medical Assistance in Dying, on the other hand (as defined in Quebec Bill 52, 2014), is a benign medical procedure, objectively indicated in cases involving “intolerable suffering” and “irremediable decline”.

Medical Assistance in Dying, therefore, is not simply a “horse of a different colour”, intruding upon our earlier assumptions. It is, in fact, an entirely different animal. For the desirability of medical procedures is not a function of the patient’s will. Wounds are bound in certain fashions, not because the patient wishes it to be so, but because clinical methods have so evolved through the experience of medical theory and practice. It doesn’t matter whether a patient is “capable”, or even conscious: wounds will be bound in the same manner. More generally: specific medical acts are practiced, in specific circumstances, because that is the correct medical thing to do. And accordingly, in virtue of the political definition of euthanasia (as a benign and high priority medical act): it is now a legal and professional fact that euthanasia is considered the “right” thing to do in cases of suffering and decline.

There was, of course, for a time, another requirement for the medical indication of euthanasia, which was the presence of a “reasonably foreseeable death” (as implied in the Quebec definition of “end of life” care, and as murkily defined in Canadian Bill C-14). With the passage of Bill C-7, however, that requirement is now swept away. All that remains of earlier, socially demanded “safeguards”, at this point, is the requirement that the person be either “competent” or “capable”, to “voluntarily request” or to “give informed consent” to euthanasia (depending in each case, on which line of that legislation we are reading).

I will not embark, here, on a discussion of the intended meaning of these divergent terms (even though they are highly significant), because I do not want to lose sight of this one main point : that it has always been assumed -- as the fundamental justification for legalization -- that Physician-Assisted-Suicide, come Voluntary-Euthanasia, come Medical-Assistance-in-Dying, must be the accomplishment of a fully competent and informed choice.

However, As I began by writing, euthanasia practice has two faces in Canada; and has actually been defined in two different and contradictory ways.

As stated above: clinically indicated medical procedures (to squarely face this unsettling horn of the dilemma) have no dependence upon choice, informed or otherwise. Quite to the contrary. In the case where a person is “incapable” of choosing for themselves, it is our collective duty and sacred responsibility to choose for them. In all probability, therefore, the next stop on the euthanasia train will involve this inevitable showdown between “competent choice”, and what our utilitarian brethren would qualify as “good medicine”; a central conflict within existing law that must apparently be settled by clarifying legislation, or through the courts.

But what are the practical implications of these facts (or, to be plain: So what)?

Simply stated: Euthanasia, in Canada, now provides the conceptual framework for killing the entire population of “incapable” persons among us.

And how so? Because “incapacity” is itself a “grievous and irremediable” condition, normally accompanied by “intolerable suffering” (according to the exterior judgement of those tasked with the care of such individuals). The only outstanding requirement, therefore, would be a judicially sanctioned affirmation of the need to allow substitution of judgement, for competent consent (where this latter is impossible).

And that means what to me?

Sixteen years ago, there was a famous case in Florida, involving a brain injured lady named Terri Schiavo. Concerned people, at that time, either defended, or lamented, the “medical” decision to withdraw food and fluids from Terri from (against the wishes of her parents, but in harmony with those of her husband). My personal opinion, I believe, although different from either faction in the absolute sense, still holds some merit. For I was sensitive to what Terri meant for my life in society. If, as I believed, Terri was in a vegetative state, then removing life-support would cause no harm. However, keeping people like Terri, alive, with simple food and fluid, provides the guarantee that others in a more questionable state would also be cared for. And thus, by degrees, I came to believe that Terri’s survival would guarantee my own survival, should I have the unfortunate luck to find myself hospitalized in an ambiguous condition, and perhaps, faced with professionals of a more determined and “realistic” utilitarian persuasion.

Already, at that time, therefore, essential questions were being asked regarding where exactly to draw the line in protecting the physical and social security of the “most vulnerable”. However, with the idea of Medically Administered Death (MAD) we have taken a giant step beyond the context described. And that is because Terri was already considered as “dead” and therefore could not be “killed”. Euthanasia, on the contrary, as defined in Canada, allows killing dependant people who are clearly alive, in every legal sense of the term. And that represents a quantum leap in both ethics and practice.

A call to proactive mobilization

This question, I believe, is of the greatest possible importance. It is also of the greatest urgency. For we are already arguing the “capability” boundary (mature minors, and advance directives). Indeed, we have already overstepped that boundary in the case of psychiatric patients.

Happily, this time there will be no need to fight a depressing rear-guard delaying action similar to our recent disappointment with “foreseeable death”. In that case, we were clearly doomed to failure because autonomous choice, and utilitarian medical ethics, were fully aligned against us. With regards to the “capability” question, however, we can truly “sock it to them”! Clearly, a reputed “right” of competent choice can NEVER justify the slaughter of the incompetent; we must demand positive legislative clarification of these ambiguities and contradictions. Immediately. Now. What is it to be (we must ask)? Is MAID an affirmation of sovereign personal choice? Or is it a medical scheme to end "suffering" by killing?

Entirely new strategic possibilities are opened with these questions; having now conceded (perforce) the central question of “freedom”, we will now be free ourselves, to reach many well meaning people who have steadfastly ignored our warnings to this point; now, that is, that the dominoes are threatening to fall closer to home. For although it might seem that the medical industry could be rationalized with euthanasia as a safety valve, or that the resources saved on the “irremediable” might be spent better elsewhere, for other interests: sooner or later, such opportunistic calculations will inevitably turn and bite. “Me today, you tomorrow” is how Alexandr Solzhenitsyn recorded the cynical catch-phrase of his Bolshevik tormentors. Or as German pastor Martin Niemoller phrased a similar idea: “First they came for the socialists ...”

It is my belief, indeed, that if we do not defend this bright line of competent choice -- together, right now -- then sooner, or later, we can expect “them” to come for us all.

Gordon Friesen, Montreal,